目的 研究曲普瑞林聯(lián)合左炔諾孕酮宮內(nèi)節(jié)育系統(tǒng)治療子宮內(nèi)膜異位癥的療效以及對(duì)其性激素水平及復(fù)發(fā)風(fēng)險(xiǎn)的影響。方法 選自深圳市龍崗區(qū)婦幼保健院于2018年9月—2021年9月收治的子宮內(nèi)膜異位癥行腹腔鏡手術(shù)患者68例，以隨機(jī)數(shù)字表法將患者分為對(duì)照組和治療組，每組各34例。對(duì)照組以左炔諾孕酮宮內(nèi)節(jié)育系統(tǒng)進(jìn)行治療，于術(shù)后第1次月經(jīng)周期3～5d時(shí)放置左炔諾孕酮宮內(nèi)節(jié)育系統(tǒng)，并進(jìn)行常規(guī)抗感染治療，月經(jīng)后進(jìn)行B超復(fù)查確定左炔諾孕酮宮內(nèi)節(jié)育系統(tǒng)是否發(fā)生位移。治療組患者則在此基礎(chǔ)上皮下注射醋酸曲普瑞林注射液，3.75mg/次，1次/月。治療組治療6個(gè)月，期間對(duì)照組持續(xù)隨訪。觀察兩組患者臨床療效，比較治療前后兩組患者排卵恢復(fù)正常時(shí)間，月經(jīng)恢復(fù)正常時(shí)間，痛經(jīng)評(píng)分，臨床量表評(píng)分，血清血管內(nèi)皮細(xì)胞生長因子（VEGF）、基質(zhì)金屬蛋白酶-9/組織金屬蛋白酶抑制物-1（MMP-9/TIMP-1）、可溶性細(xì)胞黏附因子（sICAM-1）、卵泡刺激素（FSH）、促黃體生成素（LH）和雌二醇（E₂）水平，及復(fù)發(fā)率和不良反應(yīng)。結(jié)果 治療后，治療組臨床有效率明顯高于對(duì)照組（P＜0.05），治療組排卵恢復(fù)正常時(shí)間、月經(jīng)恢復(fù)正常時(shí)間與對(duì)照組相比明顯縮短（P＜0.05）。與治療前比，治療后兩組痛經(jīng)評(píng)分及視覺模擬評(píng)分法（VAS）評(píng)分及血清VEGF、MMP-9/TIMP-1、sICAM-1、FSH、LH水平均明顯降低（P＜0.05），且治療組明顯低于對(duì)照組（P＜0.05）。治療后，兩組生理健康、心理健康評(píng)分水平均明顯升高（P＜0.05），且治療組高于對(duì)照組（P＜0.05）。治療組治療期間不良反應(yīng)總發(fā)生率、術(shù)后6個(gè)月復(fù)發(fā)率均明顯低于對(duì)照組（P＜0.05）。結(jié)論 曲普瑞林聯(lián)合左炔諾孕酮宮內(nèi)節(jié)育系統(tǒng)治療子宮內(nèi)膜異位癥能改善機(jī)體性激素水平，降低各項(xiàng)血管侵襲指標(biāo)水平，促進(jìn)月經(jīng)及排卵恢復(fù)正常周期，減輕疼痛，減少不良反應(yīng)及復(fù)發(fā)風(fēng)險(xiǎn)，提高生活質(zhì)量。

Objective To study the effect of triptorelin combined with Levonorgestrel Intrauterine System (LNG-IUS) on sex hormone levels and risk of recurrence in patients with endometriosis after operation. Methods Patients (68 cases) with endometriosis undergoing laparoscopic surgery in Shenzhen Longgang District Maternal and Child Healthcare Hospital from September 2018 to September 2021 were randomly divided into control and treatment group, and each group had 34 cases. Patients in the control group were administered with LNG-IUS at the 3rd to 5th day of the first menstrual cycle after surgery, and administered with routine anti infection treatment, B-ultrasonic reexamination was performed after menstruation to determine whether LNG-IUS was displaced or not. Patients in the treatment group subcutaneous injection administered with Triptorelin Acetate Injection on the basis of the control group, 3.75 mg/time, once monthly. The treatment group was treated for 6 months, during which the control group was followed up continuously. After treatment, the clinical evaluation was evaluated, the ovulation recovery time, menstrual recovery time and dysmenorrhea score, the clinical scale scores, serum VEGF, MMP-9/TIMP-1, sICAM-1, FSH, LH and E₂ levels, the recurrence rates and adverse reactions in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was significantly higher than that of the control group (P<0.05), the time for ovulation and menstruation to return to normal in the treatment group was significantly shorter than that in the control group (P<0.05). After treatment, the dysmenorrhea score, VAS score, serum VEGF, MMP-9/TIMP-1, sICAM-1, FSH and LH levels in two groups were significantly lower than those before treatment (P<0.05), and which in the treatment group was significantly lower than the those in the control group (P<0.05). After treatment, the scores of physical health and mental health in two groups were significantly higher (P<0.05), and the scores in the treatment group were higher than those in the control group (P<0.05). The total incidence of adverse reactions and the recurrence rate 6 months after operation in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Triptorelin combined with LNG-IUS can improve the level of sex hormone, reduce the level of vascular invasion index, promote menstruation and ovulation to return to normal cycle, reduce pain, reduce the risk of adverse reactions and recurrence, and improve the quality of life in patients with endometriosis after operation.

R984

深圳市福田區(qū)衛(wèi)生公益性科研項(xiàng)目（FTWS2016066）